Theplight of the nurse in community mental health ten ters

The extensive utilization of paraprofessionals as therapeutic agents in National Institute of Mental Health (N.I.M.H.) funded community mental health centers (Gottesfeld, Rhee and Parker, 1970; Levenson and Reff, 1970; Sobey, 1970), has brought much attention to the need for inservice staff development (Joint Commission on Mental Illness and Health, 1961; Riessman, 1967; Sobey, 1970). The importance of inservice training or supervision, especially for the partially trained staff person, has been indicated in terms of its beneficial effects for both caregiver (Rosenkrantz and Holmes, 1974; Taynor, Perry and Frederick, 1976) and carereceiver (Goodman, 1972; Karlsruher, 1974, 1976). Professionally trained, experienced staff are typically called upon to function, in part, as clinical supervisors. The role of clinical supervisor could be conceptualized, in its simplest form, as a two-fold process: the identification of staff in need of additional training or supervision, and the implementation of a training program. According to this model, one of the first questions to answer is: which staff are in need of inservice training? An obvious target for this intervention are those individuals who, because of their lack of formal training, are designated as paraprofessionals. Are paraprofessionals the only group functioning as therapeutic agents who are in need of further training? Preliminary evidence suggests that the community mental health nurse may also be in desperate need of additional training (Reres, 1969; Zahourek, 1972). The evidence suggests that community mental health nurses lack adequate previous training as mental health caregivers and have limited confidence in their clinical skills. Are supervisors aware of this situation and do they then in turn provide additional ‘on-the-job’ training? It is entirely possible that nurses are given considerable ‘professional autonomy’ even though they may have received little adequate preparation prior to job performance. It is conceivable that because of their professional status, medical education and training, nurses’ need for inservice training and supervision are overlooked as attention is directed towards the less prestigious paraprofessional. The present study examines how nurses compare with paraprofessionals and non-